Discharge Planning Advisor: Hospital’s award-winning plan for prescription drugs

Some $150,000 in free meds provided each year

A social work professional at a 100-bed hospital in Indiana is getting free medications for patients who can’t afford them with a program she says could be a model for health care organizations across the country.

Using an Internet program called IndiCare (www.indicare.com), which provides access to pharmaceutical companies that offer free drugs to needy patients, Jaris Hammond, ACSW, LCSW, social services coordinator for Hancock Memorial Hospital and Health Services in Greenfield, IN, oversaw the distribution of at least $148,500 in free medications in 2002.

She estimates the figure would be closer to $200,000 if she were able to track patients who refill their own prescriptions using cards issued by some of the drug companies.

In 2001, the program received the Eleanor Clark Award for Most Innovative Program from the Philadelphia-based Society for Social Work Leadership in Health Care.

"It can be duplicated without much effort," says Hammond. "That’s exactly why it won the award. If everybody in the country could do this, there would be no need for Medicare to pick up the cost of prescription medication."

Before the IndiCare program began, Hancock was spending about $10,000 a year to purchase medications for some 50 needy patients through its medical assistance program (MAP), she explains. Under that program, the hospital and more than 40 physicians from a variety of specialties write off the medical care they provide to patients who meet the guidelines of the federal food stamp program.

"We decided three years ago that maybe it was time to try something else" to address the need for funding for prescription drugs, Hammond says.

A Hancock pharmacist who had heard about IndiCare requested a demonstration of the program, and the hospital eventually paid $3,000 a year to tap into it, she adds. "[The pharmacist] did a trial with three or four patients and then, when she left after three or four months, the program fell into my lap." In the last few months of 2000, when the program started, about $18,000 worth of drugs were distributed, she says. For 2001, the figure was about $109,000.

IndiCare is one of seven financial assistance programs she oversees, Hammond notes. She also serves as the sole social worker for the emergency department, outpatients, obstetrics, and same-day surgery. She also handles the referrals for drug and alcohol programs, as well as for domestic violence, adult protective services and child abuse cases. "I’m the go-to’ person for our transition [discharge] planners."

That means, Hammond explains, that she would be unable to run the IndiCare program without "two wonderful volunteers." She soon will have a third, she adds. "We also have social work interns and a two-day-a-week secretary who is awesome."

"What we do is go on-line, access what medications are being offered by specific pharmaceutical companies, get the forms, and fill out what’s required for their format," she says. "It could be last year’s tax statement or, in the case of one who went into [extreme] detail, the patient’s electric bills."

Patients don’t qualify for the coverage if they are eligible for any other prescription drug coverage, including federal, state, or private insurance, Hammond notes. Most of the drug companies offer nongeneric medication through the program, she says. "If there’s a generic [substitute] for it, they won’t give it to you for free."

Patients with asthma or chronic lung disease or who need blood-pressure medication for hypertension "are great candidates for IndiCare," Hammond says.

After her office completes the IndiCare application for a patient, she explains, there is "a paper shuffle back and forth with the physicians’ lounge" to obtain authorization for the drugs. "[Physicians] sign off on the application, put it in our box, and we mail it in. Most of the medications are delivered to the physicians’ offices."

Her office tracks each case, making sure the medicine gets to the right people, and then reapplies, setting the process in motion again, adds Hammond. "The pharmaceutical companies usually send a three-months’ supply, so after two months, we reapply."

"Many people have been on the program for three years," she says, "and a lot of them don’t have any insurance at all. Sometimes, their medicine costs $1,000 a month."

Frequently, patients can afford to pay their physician but don’t have the money for their medications, Hammond notes. "In many cases, [getting the free drugs] prevents them from being hospitalized." This is particularly true for diabetics, many of whom the program helps to obtain free insulin from one pharmaceutical company and free test strips from another, she adds. "Sometimes, I have someone come to my door from the Medicare office and say, I’ve applied for Medicare, but I’ve been off my meds for two weeks.’"

In addition to the IndiCare program, patients can get help from a private fund called HELPS that is used to buy medications "in a pinch," Hammond says. That fund comes into play "if somebody’s in the emergency department [ED], for example, who needs antibiotics for a bad infection or for wound care."

Despite its relatively small size, Hancock Memo-rial Hospital and Health Services provides a wide range of services, she notes, including hospice care, cardiac catheterizations, a geriatric psychiatric unit, and a rehabilitation unit.

Part of her job, Hammond explains, is helping some of the patients who make use of those services through the seven financial assistance programs she oversees. In addition to IndiCare and MAP, she says, those programs include:

  • Senior Health Insurance Information Program (SHIIP), a volunteer program that keeps patients updated on changes in long-term care insurance and Medicare and Medicaid regulations, and provides counseling for those who need it.
  • Women Helping Women, which Hammond calls "an awesome answer to women who need mammograms and can’t afford them. We have a fund-raising dinner once a year and made close to $20,000 with this year’s dinner." She adds that the program, which gets a great deal of physician support, "could be modeled by anybody."
  • Breast and Cervical Cancer Program, a state-funded initiative for which Hammond provides the social work component. "We hired a two-day-a-week person to coordinate that program."
  • Financial Write-off Applications. "Our little office does at least 200 applications a year for people who don’t qualify for MAP, but really can’t afford to pay their bill," Hammond explains. This would include someone who "just came to the ED and had a $300 to $400 bill. We take a snapshot of their financial situation and ask for last year’s tax return and [documentation of] the last three months of income. On the basis of that information, we write off all or part of the bill. Physicians tend to write off what we write off."

[Editor’s note: Jaris Hammond can be reached at (317) 468-4532 or by e-mail at jhammond@hmhhs.org.]